Doctors fail to look past a fat person's weight

You must lose weight, a doctor told Sarah Bramblette, advising a 1,200-calorie-a-day diet. But Bramblette had a basic question: How much do I weigh?

The doctor's scale went up to 159kg, and she was heavier than that. If she did not know the number, how would she know if the diet was working? The doctor had no answer.

So Bramblette, 39, who lived in Ohio at the time, resorted to a solution that made her burn with shame. She drove to a junkyard that had a scale that could weigh her. She was 227kg.

One in three Americans is obese, a rate that has been steadily growing for more than two decades, but the health care system - in its attitudes, equipment and common practices - is ill prepared, and its practitioners are often unwilling, to treat the rising population of fat patients.

The difficulties range from scales and scanners, like MRI machines that are not built big enough for very heavy people, to surgeons who categorically refuse to give knee or hip replacements to the obese, to drug doses that have not been calibrated for obese patients.

The situation is particularly thorny for the more than 15 million Americans who have extreme obesity - a body mass index of 40 or higher - and face a wide range of health concerns.

Part of the problem, both patients and doctors say, is a reluctance to look beyond a fat person's weight.

The issues facing obese people follow them through the medical system, starting with the physical exam.

One study asked 122 primary care doctors affiliated with the Texas Medical Center in Houston about their attitudes toward obese patients. The doctors "reported that seeing patients was a greater waste of their time the heavier that they were, that physicians would like their jobs less as their patients increased in size," the researchers wrote.

Other times, doctors may be unwittingly influenced by unfounded assumptions, attributing symptoms like shortness of breath to the person's weight without probing likely causes.